The most common heart attack symptom in women is the same as in men: chest pain, pressure, tightness or discomfort. What differs is that women are more likely to have other symptoms along with it, such as shortness of breath, nausea, unusual tiredness, or pain in the back, jaw, neck or arm.
A heart attack can also happen with little or no chest pain. If you think you might be having one, do not wait until you are sure. Call 911.
Key takeaways
- Chest pain, pressure or tightness is the most common heart attack symptom in women, just as it is in men.
- Women more often have other symptoms as well, such as breathlessness, nausea, unusual tiredness, or back, jaw, neck or arm pain.
- A heart attack can happen without chest pain, so a lack of it does not rule one out.
- If you think you may be having a heart attack, call 911 and do not drive yourself.
- Women's symptoms are more often put down to stress, so describe everything and say you are worried about your heart.
When to call 911
Call 911 right away if you have chest pain, pressure, squeezing or tightness, or sudden shortness of breath, a cold sweat, nausea, lightheadedness, or pain spreading to your back, jaw, neck, arm or upper stomach. Do not drive yourself to the hospital. Do not wait to see if it passes.
This is the official advice, not extra caution. The US chest pain guideline says people with acute chest pain or equivalent symptoms should seek medical care immediately by calling 911.1
You do not need to be certain, and you do not need every symptom on the list. No one can tell a heart attack from something else at home. That takes an electrocardiogram and blood tests. Calling is the right decision even if the cause turns out to be something else.
What is the same: chest symptoms come first
There is a common belief that women's heart attacks rarely involve the chest. The evidence says otherwise.
A US study interviewed 2,009 women and 976 men aged 18 to 55 who were in the hospital for a heart attack. Chest pain, defined as pain, pressure, tightness or discomfort, was reported by 87.0% of the women and 89.5% of the men.2
The word "pain" can mislead. Many people describe pressure, heaviness, squeezing, fullness or an ache instead. If that is what you feel, it counts.
What is different: more symptoms at once
The difference is in what comes with the chest symptoms. In the same study, 61.9% of women had three or more additional symptoms, compared with 54.8% of men. The American Heart Association has reviewed these sex differences in a scientific statement on heart attacks in women.23
| Common in both women and men | More likely in women than in men |
|---|---|
| Chest pain, pressure, tightness or discomfort | Shortness of breath |
| Pain spreading to one or both arms | Nausea, vomiting or upper stomach discomfort |
| Cold sweat | Pain in the back, between the shoulder blades, jaw or neck |
| Lightheadedness | Unusual tiredness or weakness, and palpitations |
None of the symptoms in the right-hand column is a "female" symptom. Men have them too. Women simply have them more often, and more of them together.
Heart attacks without chest pain
Most women having a heart attack do have chest symptoms, but not all. In the study above, about 13% of women reported none. Among patients with the most severe type of heart attack, women were more likely than men to arrive without chest pain.2
So the absence of chest pain does not rule a heart attack out. Sudden shortness of breath, a cold sweat, nausea, or pain in the back, jaw or arm that you cannot explain is reason enough to call 911, with or without chest symptoms.
Symptoms in the days and weeks before
Some women notice changes before a heart attack. In a survey of 515 women who had had one, 95% recalled new or different symptoms beforehand. The most frequent, reported more than a month before, were unusual fatigue, sleep disturbance and shortness of breath.4
These findings need care. The women were asked months afterward, and the researchers said it remains unknown whether such symptoms can predict a heart attack. Fatigue and poor sleep are also very common for many other reasons.
The practical advice is simple. If you have a new symptom you cannot explain, such as tiredness that is out of character or breathlessness doing things that used to be easy, see your doctor promptly and say that you are concerned about your heart. If symptoms are sudden, severe or getting worse, call 911.
Why women's symptoms get missed
Both women and their clinicians are less likely to connect symptoms to the heart. In the study of younger heart attack patients, women were more likely than men to put their symptoms down to stress or anxiety. Among those who had sought care for similar symptoms before their heart attack, 53% of women said their provider did not think the symptoms were heart-related, compared with 37% of men.2
The US chest pain guideline addresses this directly. It states that women are at risk of underdiagnosis and that cardiac causes should always be considered, and it advises against calling chest symptoms "atypical".1
What this means for you:
- Describe every symptom, not only the one that seems most serious.
- Say plainly, "I am worried this is my heart."
- If symptoms continue or return after you have been sent home, go back or call 911.
What to do in the moment
- Call 911. Say you think you may be having a heart attack.
- Do not drive yourself, and do not ask a family member to drive you if an ambulance is available.
- Stop what you are doing and stay on the line. Follow the dispatcher's instructions.
- Do not wait for someone to tell you it is serious enough.
Signs of heart disease in women
Heart disease usually builds for years, and its early signs are easy to blame on age or stress. Watch for:
- Breathlessness or tiredness with effort that used to be easy, which eases when you rest.
- Discomfort in the chest, jaw, arm or upper back that comes on with exertion or stress.
Women are more likely than men to have these symptoms without a major blockage on an angiogram. A European expert consensus noted that this pattern, often caused by spasm or disease of the small heart arteries, is frequently misdiagnosed as non-cardiac and is not harmless.5
Some risk markers are specific to women and cannot be felt at all:
- Pregnancy complications. An American Heart Association statement links high blood pressure disorders of pregnancy, gestational diabetes, preterm delivery and pregnancy loss to a higher later risk of heart disease.6 See pregnancy complications and later heart risk.
- Early menopause. In a UK Biobank study, natural menopause before 40 was linked to a 36% higher risk of cardiovascular disease, and surgical menopause before 40 to an 87% higher risk.7
- Autoimmune disease. In a UK study of 22 million people, those diagnosed with an autoimmune disease, most of them women, developed cardiovascular disease at about one and a half times the rate of matched controls.8 See autoimmune disease and heart risk.
Mention any of these whenever your heart risk is assessed. New symptoms with effort deserve a prompt visit to your doctor; sudden or severe symptoms mean calling 911.
After the emergency message: prevention
Everything above is about what to do during symptoms. Prevention is a separate matter and it happens long before, when you feel well. Heart risk in women often rises in midlife, which our guide to menopause and heart disease risk explains.
If you have no symptoms and want to understand your own risk, our guide to a heart disease risk assessment describes what is checked. The Cardio Res-Q program page has a three-question screener. Cardio Res-Q is a prevention program. It is not emergency care and is not for symptoms that are happening now.
Are You a Candidate for Cardio Res-Q?
Three quick questions about the risk factors we screen for. Your answers stay between you and the clinic.
Frequently asked questions
Can a woman have a heart attack without chest pain?
Yes. Most women having a heart attack do have chest pain, pressure or discomfort, but a meaningful minority do not. Sudden shortness of breath, a cold sweat, nausea, or unexplained pain in the back, jaw, neck or arm should be treated as an emergency whether or not your chest hurts.
How can I tell a heart attack from anxiety or indigestion?
You cannot tell at home, and neither can a doctor without tests. The symptoms overlap, and research shows women's heart symptoms are often put down to stress. If you have symptoms that could be a heart attack, call 911 and let the emergency team work out the cause.
What does heart attack chest pain feel like in women?
It is often described as pressure, tightness, squeezing, heaviness or fullness in the chest instead of sharp pain. It may come with shortness of breath, nausea, sweating, or discomfort in the back, jaw, neck or arm. Any of these descriptions is a reason to call 911.
Do warning signs always come on suddenly?
No. Some women recall symptoms such as unusual fatigue or breathlessness in the weeks before a heart attack, though it is not known how well these predict one. New symptoms you cannot explain deserve a prompt visit to your doctor, and sudden or severe symptoms mean calling 911.
Related reading
This article is for general education and is not medical advice. Decisions about testing and medication should be made with your clinician. If you have chest pain or other symptoms of a heart attack, call 911.
